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FACILITIES HOUSEKEEPING INSPECTION FORM Department Area: ______________________________ (Once per shop weekly) (2 points)

Check each item in appropriate weekly column for items that are in proper operating condition. If item is defective, mark with X, explain in comments section

below, and advise supervisor. If item is not applicable, write "NA" in the box. Add other appropriate items to list as necessary.

Date →

Conducted by→

Work Order Number→

Floors and Other Areas

Week 1

Week 2

Week 3

Week 4

Week 5

Are floors clean and clear of waste? Are signs posted to warn of wet floors? Are floors in good condition? Are there holes, worn or loose tile or carpet sticking

up? Are personal items, such as clothing and lunch boxes, in assigned lockers or storage areas? Is the work area cluttered? Aisles and Stairways

Are aisles unobstructed and clearly marked? Are aisles wide enough to accommodate workers and equipment comfortably? 3ft Is the workplace lighting adequate? Are Stairs well lit? Are faulty stair treads repaired? Spill Control

Are all spills wiped up? Are procedures followed as indicated on the safety data sheets? Are spill absorbents used for greasy, oily, flammable or toxic material? Are used rags and absorbents disposed of promptly and safely? Is a spill area surrounded by barrier to prevent a spill from spreading? Waste Disposal

Are there adequate number of waste containers? Are there separate and approved containers for toxic and flammable waste? Are waste containers located where the waste is produced and labeled? Are toxic and flammable waste chemicals handled properly? Storage

Is material stacked securely, blocked or interlocked if possible? Are materials stored in areas that do not obstruct stairs, fires escapes, exits or

firefighting equipment? Are materials stored in areas that do not interfere with workers or the flow of

material? Are bins and racks provided where material cannot be piled? Are all storage areas clearly marked? Do workers understand material storage and handling procedures? Fire Prevention

Are combustible and flammable materials present only in the quantities needed for

the job at hand? Are combustible and flammable materials kept in safety cans during use? Are sprinkler heads clear of stored material? Flammable Storage cabinets labeled "Flammable". Are fire extinguishers inspected and mounted? Are oily or greasy rags placed in metal containers and disposed thru waste

management? Chemical Storage & Safety

Chemical containers properly labeled, stored, and closed when not in use. Refrigerators/Freezers properly labeled. Chemical stocks purged of old, outdated, and unusable chemicals. Compressed Air and Compressed Gasses

Compressed air 30 psi or less for machine/part cleaning, 10 psi for clothing. Gas cylinders legibly marked as to their contents. Gas cylinders stored away from high heat, flames, etc. Gas cylinders, valves, couplings, regulators kept free of oil and grease. Empty gas cylinders labeled "Empty" closed, and caps on. Hazardous Waste & Material Disposal and Recycling

Fluorescent, HID, Mercury vapor lamps recycled properly. Non-alkaline batteries (lead acid, Ni-cad, silver, etc.) managed for recycling. Manuals, Training, SOP's, SDS's

Standard Operating Procedures & Safety Data Sheets readily available. Safety Equipment and Emergency Preparedness

Eyewash & safety shower unobstructed and inspected as required. Appropriate spill kit available and stocked. Emergency contact information posted by entrance. Electrical Safety

Extension cords are not used as permanent wiring. Extension cords and power strips not daisy-chained one to another. Electrical cords not under carpet/rugs, through doorways, or high traffic areas. Power cords are in good condition with no splices or broken insulation. Grounding prongs not removed from 3 way plugs. Outlet, switch and junction box covers are in place and in good repair. Electrical outlets not overloaded with appliances, i.e. splitters used. Energized parts, circuits, and equipment guarded against accidental contact. General Work Environment & Indoor Air Quality

Noise levels are within acceptable limits or engineering controls established. Areas with high noise levels posted and hearing protection required to be used.

Managers Signature:

Safety Team Member Signature: Comment:

Please scan completed Housekeeping Inspection forms and send to Tim Nix monthly for safety incentive points.

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